Lowering barriers to physical therapy decreases the odds that people with low-back pain will end up in emergency rooms, use imaging and have opioid prescriptions, according to a recent policy brief by the Health Care Cost Institute.
The Health Care Cost Institute’s findings, based on an analysis of private insurance claims data, seem to support a recent decision by the Oregon Health Authority to allow Medicaid patients to access physical therapy and other alternative therapies for low-back pain, in hopes of reducing opioid dependence, said Bianca Frogner, director of the University of Washington Center for Health Workforce Studies, which analyzed the HCCI data.
The Oregon Health Plan’s policy on back-pain treatment, which has not yet taken effect, would put the state’s Medicaid population on par with people who have private insurance in terms of access to physical therapy. The state put off allowing the policy to take effect, however, because of uncertainty about the cost.
Oregon Health Authority spokeswoman Stephanie Tripp said the state is awaiting results of an actuarial analysis, and an effective date could be decided as early as March 19.
Low-back pain is the most common type of pain in the United States, according to the HCCI policy brief, with 25 percent of the population reporting at least one day of pain within the last three months. It’s also the top contributor to the number of years one lives with a disability. Low-back pain is estimated to cost $90.6 billion in direct health care, plus another $19.8 billion in missed work, disability and low productivity.
Frogner and her colleagues looked at health care utilization and costs for a one-year period from the point of diagnosis for all episodes of low-back pain happening between 2009 and 2013 in six Northwest states. During that period, three states, including Oregon, had regulations that restricted patients’ access to physical therapy.
The authors looked at physical therapy versus other forms of health care because previous studies suggest early PT helps avoid unnecessary and expensive procedures.
During the period that was studied, Oregon allowed patients to go to physical therapists without a referral from a doctor, but only for 60 days at a time. That regulation has since been removed.
Physical therapists have been lobbying across the country to loosen regulations on access to their care. As of Jan. 1, 2015, all 50 states were allowing some form of direct access to a physical therapists. Eighteen states allow completely unrestricted access with no physician referral.
The HCCI study found that patients seeing a physical therapist before other providers had lower costs and lower chances of visiting an emergency room, using imaging and opioid prescriptions. But they also found that state policy wasn’t the only factor.
When comparing patients who used physical therapy first, versus later in treatment, the authors found that costs in restricted states, including Oregon and Washington, were lower. “It might be something more telling about the state itself,” Frogner said. “They might be doing things like using lower-cost providers, in general.”
When patients didn’t see a physical therapist first, the authors found the most common first stop was a chiropractor.
“People want a quick solution to their pain,” Frogner said. “You can probably get an appointment faster with some of these people than you can your primary-care provider.”
Patient and doctor awareness, plus the density of PTs practicing in an area, could be important factors in whether and when people turn to physical therapy, Frogner said.
Based in Washington, D.C., HCCI was launched in 2011 to gather and analyze data on health care spending among the majority of the U.S. population, which is covered by private insurance. Most health cost studies rely on data from Medicare, which covers disabled and elderly people.
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